Audit & Monitoring

Manage CMS program audit with the touch of a button

Demystify CMS Program Audit Management

Build orderly universes in the beginning to achieve the biggest bang at the lowest cost​

Since the CMS program audit utilizes various universes—such as Part C Organization Determinations, Appeals and Grievances (ODAG), Part D Coverage Determinations, Appeal and Grievances (CDAG) and Medicare-Medicaid Plan Service Authorization Requests, Appeals and Grievances (SARAG)—to evaluate health plan performance, it’s essential for audit and monitoring teams to leverage real-time data. Yet, despite current innovations to address CMS Program Audits, it has been a perpetual challenge for health plans to create and submit accurate, timely universes to avoid invalid data submissions and poor audit scores.

Many healthcare organizations still rely on time-consuming manual program-audit processes, which are often riddled with errors, inconsistencies or both. However, having over 125 years of combined audit and monitoring expertise, Inovaare knows that by automating the process, health plans can be better prepared to generate and validate accurate, clean universes that are ready for submission. As a result, they will improve operational efficiency and achieve a healthier bottom line.

Minimize program audit errors with workflow automation

Internal & External Audits

Inovaare understands the chaos and stress that occurs when program audit notifications strike. Its audit and monitoring experts lived it for decades while leading some of the largest health plans in the United States. So its cloud-based audit and monitoring module empowers health plans to manage all of their program audit and monitoring needs. Fully customizable and configurable, not only does Audit Management deliver real-time results for any program audit and monitoring process, it provides compliance validation, as well. Compliance teams can now easily store and manage audit questionnaires and worksheets regarding findings, non-compliance, observations, documentation and all relevant corrective actions within one centralized system. Audit life cycles—from audit planning and scheduling, checklist preparation, field data entry, audit report generation to corrective action and risk mitigation actions—can now be completed with ease. This fully integrated tool with a built-in risk assessment feature is customizable to meet any-sized health plan's unique requirements.

SINGLE-CLICK CMS UNIVERSES FOR PROGRAM AUDITS

Universe Generation

This cloud-based CMS compliance software module can be pre-built for single-click report generation. Each report created conforms to the approved layout and data-type format accepted by regulatory authorities. Universe Generation automates the query process so compliance teams can sustain a state of audit readiness at all times, when it's utilized for routine market monitoring. By expediting report turnaround times—while reducing the risk of penalties and low star ratings—Universe Generation offers a significant return on investment. It pays to be proactive.

Auditing and Monitoring compliance Solutions
Auditing and Monitoring
AUTOMATED SCRUBBING OF CMS PROGRAM AUDIT REPORTS

Universe Scrubber

Inovaare knows that one of the most arduous, time-consuming activities for a Medicare health plan is the creation of required universes for CMS report submission. Universe Scrubber automatically scrubs reports for authorizations, claims, and appeals and grievances—on demand—to validate CDAG, ODAG, SARAG and other regulatory universes in real time. As a plug-and-play solution embedded with standard business rules, it can be used with no installation requirements. Universe Scrubber promotes transparency and control by offering configurable methods to strategically plan audits. Even delegated entities can be validated and consolidated into the final report for submission.

FDR MANAGEMENT FOR END-TO-END CMS PROGRAM AUDIT COMPLIANCE

Delegation Oversight

It's a challenge to manage first-tier, downstream and related entities (FDR) and ensure compliance when a Medicare Advantage plan sponsor opts to outsource administrative functions. It requires a systematic review of FDR operations—to ensure they are in line with business imperatives. Inovaare's Delegation Oversight empowers plan sponsors and MCOs to manage and track all audits and monitoring of delegated entities.

Auditing and Monitoring compliance

Key Program Audit & Monitoring Benefits

  • Intuitive real-time dashboards and reports for health-plan management, audit committees and stakeholders
  • Standardized workflow-driven audit processes that minimize errors
  • Optimized audit-process visibility, simplifying risk management and compliance
  • Expedited feedback processes to mitigate operational and enterprise risks
  • Increased productivity, by facilitating collaboration within your organization
  • Tracked findings, recommendations and action plans

Program Audit and Monitoring Packages

Compliance Audit Pro 30 and Audit & Compliance Audit Enterprise

Inovaare knows the world of Medicare, Medicaid and Commercial health plans from decades of hands-on Audit & Monitoring department oversight. This expertise resulted in a program audit and monitoring software platform rich in features and it’s unparalleled in the market.

Inovaare created two program audit and monitoring software packages to meet any health plan’s unique requirements: Compliance Audit Pro 30 and Compliance Audit Enterprise. For many health plans, Compliance Audit Pro 30 is an out-of-the-box solution that can be implemented within 30 days to lower operating costs and improve member experience. However, for payers who require more complex processes, Compliance Audit Enterprise can be customized to address each requirement.

Compliance Audit Pro 30

Quick implementation solution for health plans
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  • Automated Universe Scrubber
  • Plug-and-play error validation
  • CMS-mandated business rules
  • All ODAG, CDAG & SARAG universes
  • Internal audit
  • Secure, HIPAA-compliant server
  • Built-in audit workflows
  • Standard support
  • Standard reporting & dashboards
  • Standard Audit Suite Upgrades
  • External audit
  • Delegation oversight audit
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Compliance Audit Enterprise

Customized implementation solution for health plans
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  • Automated Universe Scrubber
  • Plug-and-play error validation
  • CMS-mandated business rules
  • All ODAG, CDAG & SARAG universes
  • Internal Audit
  • Secure, HIPAA-compliant server
  • Fully customized workflows
  • Advanced support
  • Advanced reporting & dashboards
  • FDR Portal
  • External audit
  • Delegation oversight audit
  • Customizable alerts
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